Medicaid is federally funded health insurance for low-income individuals and families. Each state regulates its own unique Medicaid program and sets specific age, income and resource requirements for applicants. Although states have some discretion, there are mandatory eligibility groups. The federal government has specific income guidelines the state must follow when offering Medicaid to the mandatory eligibility categories.
Pregnant Women and Infants
Income limits are typically higher for pregnant women than other eligibility groups. In many states, including California and New York, pregnant women are allowed to earn 200 percent of the federal poverty level (FPL). In Florida, pregnant women are limited to 185 percent of the FPL. Services may be limited in some states. Pregnant women usually receive coverage for up to two months after delivery. No resource limits usually apply since coverage is temporary. Infants born to Medicaid-eligible women will be covered for the first year of life, provided the mother remains within the income guidelines for the household.
States are required to cover children under 6 years of age whose household income is no more than 133 percent of the FPL. Medicaid requires that all states extend coverage up to age 19 for children born after September 30, 1983. Limits are generally lower for children ages 6 through 19. In Indiana, the income limit for children is 100 percent. Resource limits may apply to children.
Parents, Elderly, Disabled and Blind
Parents who have children living in the household are eligible for Medicaid. Income limits are generally lowest for parents. There are no federal income guidelines specified for parents. In Florida, working parents can earn 55 percent of the FPL. Non-working parents are allowed to receive only 21 percent. Supplemental Security Insurance recipients are generally automatically eligible for Medicaid. Individuals who receive Medicare can apply for Medicaid to supplement their coverage. To receive coverage through the Qualified Medicare Beneficiary program, the applicant's income must be at least 120 of the FPL, but no more than 135 percent of the FPL. Resource limits usually apply to these categories. Limits range from $1,000 to $4,000 for an individual and up to $6,000 for a couple.
Most states offer a medically needy or spend-down program to provide coverage to applicants who meet the eligibility criteria but not the income requirements. Applicants who exceed the income limit and have excessive medical debt may be able to use monthly bills to reduce their income. If the income guidelines are met after subtracting medical debt, coverage will be awarded. The income limits vary, depending on the state. In Michigan, individuals are limited to 57 percent of the FPL and couples 56 percent. In New York, individuals are allowed 87 percent and couples 93 percent.